Only sympathy

As rewarding as treating emergency pts may be,
its never fun to treat pts presenting with pain... especially when u caused it

10 yrs from now... long into my career, I prob will never forget this patient I hav
she was the first patient I treated since 2nd yr
and in the 2 yrs Ive seen her, her mouth is almost a living proof of all my mistakes, my clinical incompetence...a reminder to myself to do better next time
In a way, I really owe her my career given that ive tried just about all treatment types ive ever learnt on her

Since the 2nd yr, I scaled and root planed her teeth for over a yr
when I learnt about root caries, there she was...my first clinical case of sort
when I learnt of patients with hyposalivation, she was one...always was one... I was just too dumb to recognised it in the 2nd yr when I first saw her
she was the first patient who seriously challenged my operative skill
one poorly accessed, packed and marginalised filling after another followed by a root canal treatment because of my failed interventions
I prob will make a crown or extract her tooth some times in the near future too...perhaps making her a denture

My perio treatment didnt 'heal' and she came back with root caries
I learnt then that I shouldve applied fluoride after root planning
The root caries were the deepest I'd ever attempted to fill. I couldnt isolate, or fill the tooth well
my second attempt failed just as miserably.
I learnt then how to adapt the matrix band well and the method of packing GIC
She was still in pain because the fillings were very close to the pulp
In the end, I had to take the pulp out and wasted all the treatments I tried before hand
In the process, I perforated the root and learnt once again how to refine my endo access preparation

I had an argument with the demonstrator over the treatment option and was really annoyed The tooth had no long term prognosis. I couldnt make a crown for her even if root canal treatment was successful.
I tried filling it 3 times, I knew how far down the margin of the tooth was.
If I took the tooth out, the gum condition of the surrounding teeth may improve as well as her cleaning. The demonstrator told me to keep it.
This situation is classic. Never root canal treated the tooth that cannot be restored.

Prof Morgan's lecture this week really put a lot of things in perspective too.
In public dental health, we are concentrating on treating the population and not the individuals. we cant afford luxuries in public health and should be spending time treating patients to an acceptable level of dental health instead of wasting money, time and resources on teeth with hopeless prognosis.

If Dr. Stacey reviewed this patient in the final year case presentation, I will never be qualified as a dentist.
This patient is a classic example of what not to do in term of treatment planning.
-A patient with poor oral hygiene but has a mouth full of root filled teeth which prob will fall out in a yr or so

Just last week, I filled another tooth with root caries. I told her that the radiographic evidence showed that there was a decay underneath the filling.
Though I thought I did a good fill on that tooth, she called up this week with severe radiating pain coming from that tooth and a facial swelling.
The pulp was taken out in primary care. Again, this raised a question whether I should've filled it.
The patient was asymptomatic. Most patients would not be happy if they get pain after the dentist intervened with the tooth which was initially fine.
By leaving the tooth in a diseased but asymptomatic state, we may be able to buy more time for the tooth, maybe for a better restorative technology......who knows

I learnt... not to let these things bother me...
cos theres nothing to be sori for
cos I still believe that clinically it was the right thing to do...to attempt a fill

so...No regret, only sympathy

07-08-08 : I was right. The tooth prognosis was poor but who wouldve imagined it giving away so soon. The patient came back with fractured fillings all around the tooth. It has been extracted today.